OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Clinical Skills in Adult Nursing Published and forthcoming Oxford Handbooks Oxford Handbook of Acute Medicine 2/e Oxford Handbook of Anaesthesia 2/e Oxford Handbook of Applied Dental Sciences Oxford Handbook of Cardiology Oxford Handbook of Clinical and Laboratory Investigation 2/e Oxford Handbook of Clinical Dentistry 4/e Oxford Handbook of Clinical Diagnosis 2/e Oxford Handbook of Clinical Examination and Practical Skills Oxford Handbook of Clinical Haematology 3/e Oxford Handbook of Clinical Immunology and Allergy 2/e Oxford Handbook of Clinical Medicine - Mini Edition 7/e Oxford Handbook of Clinical Medicine 7/e Oxford Handbook of Clinical Pharmacy Oxford Handbook of Clinical Rehabilitation 2/e Oxford Handbook of Clinical Skills in Adult Nursing Oxford Handbook of Clinical Specialties 8/e Oxford Handbook of Clinical Surgery 3/e Oxford Handbook of Complementary Medicine Oxford Handbook of Critical Care 3/e Oxford Handbook of Dental Patient Care 2/e Oxford Handbook of Dialysis 3/e Oxford Handbook of Emergency Medicine 3/e Oxford Handbook of Endocrinology and Diabetes 2/e Oxford Handbook of ENT and Head and Neck Surgery Oxford Handbook of Expedition and Wilderness Medicine Oxford Handbook for the Foundation Programme 2/e Oxford Handbook of Gastroenterology and Hepatology Oxford Handbook of General Practice 3/e Oxford Handbook of Genitourinary Medicine, HIV and AIDS Oxford Handbook of Geriatric Medicine Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Evidence Oxford Handbook of Medical Sciences Oxford Handbook of Nephrology and Hypertension Oxford Handbook of Neurology Oxford Handbook of Nutrition and Dietetics Oxford Handbook of Obstetrics and Gynaecology 2/e Oxford Handbook of Occupational Health Oxford Handbook of Oncology 2/e Oxford Handbook of Ophthalmology Oxford Handbook of Paediatrics Oxford Handbook of Palliative Care 2/e Oxford Handbook of Practical Drug Therapy Oxford Handbook of Pre-Hospital Care Oxford Handbook of Psychiatry 2/e Oxford Handbook of Public Health Practice 2/e Oxford Handbook of Reproductive Medicine and Family Planning Oxford Handbook of Respiratory Medicine 2/e Oxford Handbook of Rheumatology 2/e Oxford Handbook of Sport and Exercise Medicine Oxford Handbook of Tropical Medicine 3/e Oxford Handbook of Urology 2/e Oxford Handbook of Clinical Skills in Adult Nursing Jacqueline Randle Associate Professor, School of Nursing, Clinical Skills Lead for Masters of Nursing Science, School of Nursing, Midwifery & Physiotherapy, University of Nottingham, UK Frank Coffey Consultant in Emergency Medicine, Nottingham University Hospitals NHS Trust, Associate Professor and Consultant in Advanced Clinical Skills to the School of Nursing, Midwifery & Physiotherapy, University of Nottingham, UK Martyn Bradbury Clinical Skills Network Lead, School of Nursing and Community Studies, Faculty of Health and Social Work, University of Plymouth, UK OXFORD UNIVERSITY PRESS OXTORD UNIVERSITY PRESS Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2009 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Oxford handbook of Clinical Skills in Adult Nursing / Jacqueline Randle ... [et al.]. Typeset by Cepha Imaging Private Ltd., Bangalore, India Printed in China on acid-free paper by Asia Pacific Offset Limited ISBN 978-0-19-921104-3 10 9 8 7 6 5 4 3 21 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misap- plication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding. v Preface The range of clinical skills performed by nurses is expanding rapidly and the boundaries that previously existed between healthcare workers are blurring. Procedures once the preserve of doctors, such as detailed patient assessment and complex practical procedures, are now being per- formed by nurses. Although this book is aimed primarily at nurses, many of the procedures are also undertaken by other healthcare workers. The range and complexity of clinical skills can be as daunting for experienced practitioners as they are for students and newly qualified practitioners. We hope that the body-systems framework, alongside detailed evidence based, step-by-step descriptions for each clinical procedure will enable this book to be a practical workplace aid as well as a valuable teaching and learning tool. We have endeavoured to incorporate many of the newer skills performed by healthcare workers while ensuring that the core skills, traditionally undertaken by nurses, are also included. The professional issues that underpin the performance of all clinical skills are outlined at the outset. The 'practice tips' and 'pitfalls' sections are a distinctive feature of the book. The 'practice tips' offer helpful advice from the authors' experiences to facilitate perfromance of the skill. The 'pitfalls' sections alert the reader to potential difficulties and complications that may be encountered. Regardless of who is undertaking a clinial skill, it is paramount that the patient receives the highest standard of care. It is important to remember that clinical skills form part of the total care package and that concepts underpinning high quality care, such as effective communication, clinical governance and patient involvement should always be considered along with the performance of the actual skill itself. Local guidelines may differ for some of the procedures described in this book and we would urge you to follow local policies and be aware of, and understand the reasons for any differences. Finally, we hope that you learn as much from this book as we have from editing it and the ultimate beneficiaries will be the patients we care for. JR FC MB This page intentionally left blank vii Contents Preface v Contributors ix Abbreviations xi 1 Principles 1 2 Communication skills 15 3 Assessment of the patient 23 4 Infection control 75 5 Pain management and 'last offices' 105 6 Drug administration 125 7 Peripheral intravenous access and care 159 8 Care of the theatre patient 187 9 Emergency and high-dependency care J201 10 Respiratory system 285 11 Cardiovascular system 363 12 Gastrointestinal system 397 13 Genito-urinary system 455 14 Musculoskeletal system 493 15 Wound care 533 16 Neurology JIL 17 Ear-nose-throat system 609 18 Ophthalmology 633 19 Haematology 659 Index 673 This page intentionally left blank ix Contributors Janet Barker Pat Frakes Associate Professor, Director Emergency Nurse Practitioner, of Undergraduate Dipbma/BSc Emergency Department, (Hons) in Nursing, School of Nottingham University Hospitals Nursing, Midwifery & Physiotherapy, NHS Trust, UK University of Nottingham, UK Kate Johnson Martyn Bradbury Formerly Senior Lecturer in Clinical Skills Network Lead, Cardiac Nursing, City University, School of Nursing and Community London, UK Studies, Faculty of Health and Keith Knox Social Work, University of Plymouth, UK Charge Nurse, Eye Casualty Department, Head and Neck Fiona Branch Directorate, Nottingham Nurse Consultant, Critical Care University Hospitals NHS Trust, Clinical Lead Specialist Support, UK Nottingham University Hospitals lain Neely NHS Trust, UK Clinical Nurse Trainer, Emergency Brenda Clarke Department, Nottingham Associate Lecturer, University Hospitals NHS Trust, Open University, UK UK Mitch Clarke Rachel Peto Infection Prevention and Control Lecturer, School of Nursing, Nurse Specialist, Nottingham Midwifery & Physiotherapy, University Hospitals NHS Trust, University of Nottingham, UK UK Yvonne Powell-Richards Frank Coffey Registered Nurse, Nottingham Consultant in Emergency University Hospitals NHS Trust, Medicine, Emergency Department, UK Nottingham University Hospitals NHS Trust, Associate Professor and Jacqueline Randle Consultant in Advanced Clinical Associate Professor, Clinical Skills Skills, School of Nursing, Midwifery Lead for Masters of Nursing & Physiotherapy, University of Science, School of Nursing, Nottingham, UK Midwifery & Physiotherapy, University of Nottingham, UK Paul Crawford Professor, School of Nursing, Midwifery & Physiotherapy, University of Nottingham, UK